Healthcare Provider Details

I. General information

NPI: 1225480585
Provider Name (Legal Business Name): JOSHUA STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 GROOMETOWN RD
GREENSBORO NC
27407-6525
US

IV. Provider business mailing address

814 MILTON ST
GREENSBORO NC
27403-2229
US

V. Phone/Fax

Practice location:
  • Phone: 336-856-7437
  • Fax:
Mailing address:
  • Phone: 336-509-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26262
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: